A nurse is caring for a client who experienced a lacerated spleen and has been on bedrest for several days. The nurse auscultates decreased breath sounds in the lower lobes of both lungs. The nurse should realize that this finding is most likely an indication of which of the following conditions?

A. Polyuria: Polyuria, or excessive urination, is not typically associated with cervical spinal cord injury. In fact, urinary retention or neurogenic bladder is more commonly observed due to disruption of bladder control. Clients with cervical spinal cord injury often experience bladder dysfunction, which can lead to urinary retention rather than polyuria.
B. Hypotension: Hypotension is a common complication of cervical spinal cord injury, particularly in cases involving injury above the level of T6. Damage to the sympathetic nervous system can result in neurogenic shock, characterized by vasodilation and bradycardia, leading to hypotension. Monitoring for signs of hypotension, such as decreased blood pressure and altered mental status, is essential for early intervention and prevention of complications.
C. Weakened gag reflex: Cervical spinal cord injury can impair the gag reflex due to disruption of the glossopharyngeal nerve (CN IX) and vagus nerve (CN X) function. This impairment can lead to difficulty swallowing, aspiration risk, and increased susceptibility to respiratory complications such as aspiration pneumonia. Therefore, monitoring the gag reflex and assessing for signs of dysphagia are crucial in clients with cervical spinal cord injury to prevent respiratory compromise and aspiration-related complications.
D. Hyperthermia: Hyperthermia is less commonly associated with cervical spinal cord injury. However, in some cases, autonomic dysreflexia—a potentially life-threatening condition—can occur, leading to increased body temperature among other symptoms. This is more common in injuries above the T6 level.
E. Absence of bowel sounds: Neurogenic bowel dysfunction, including the absence of bowel sounds, is a common complication of cervical spinal cord injury. Disruption of autonomic nervous system function can lead to decreased peristalsis and absent bowel sounds.

A. Apply 4 to 5 ml of liquid soap to the hands: This is the correct action. Applying an adequate amount of soap ensures effective cleaning of the hands. The recommended amount is typically 3 to 5 ml or enough to cover the entire surface of the hands.
B. Hold the hands higher than the elbows: This is incorrect. When performing hand hygiene, the hands should be held lower than the elbows to prevent water from running down the arms and contaminating previously cleaned areas.
C. Rub hands and arms to dry: This is incorrect. After washing the hands, they should be dried using a clean paper towel or air dryer. Rubbing hands and arms to dry is not recommended as it can lead to friction and potential skin irritation.
D. Adjust the water temperature to feel hot: This is incorrect. The water temperature should be warm, not hot, to prevent skin damage or discomfort. Hot water can strip the skin of its natural oils and lead to dryness or irritation.